Different Clinical Types and Stages of Rehabilitation Treatment

Rehabilitation for Hospitalized Patients with COVID-19

As the conditions of COVID-19 hospitalized patients vary, the possible dysfunction may also vary. In clinical practice, make comprehensive rehabilitation assessments according to patients’ characteristics and classify them accurately. In a timely manner, detect patients’ functional impairment and its severity, and conduct corresponding comprehensive rehabilitation treatment.

Rehabilitation Treatment for Mild Patients

Mild patients meet the diagnostic criteria for suspected/confirmed cases of Notice on Issuance of COVID-19 Diagnosis and Treatment Protocol (7th Trial Edition). Patients with mild symptoms and no imaging manifestations are taken in single rooms for isolation and medical observation.

9.3.1.1.1 Objectives of Rehabilitation Treatment

The main objectives are to improve patients’ clinical symptoms, establish a correct cough mode, improve their immunity, prevent cold, prevent pneumonia and pulmonary function decline, and establish their confidence to overcome the disease.

• 9.3.1.1.2 Rehabilitation Treatment Methods
• 1) Position management: The primary purpose is to reduce respiratory work, increase effective lung volume by adjusting the patient’s position, and reduce the adverse effects of supine posture on lung ventilation and perfusion. Patients can raise the head of their beds to 60° or they should lean forward while sitting or standing.
• 2) Cough training: Inhale deeply and quickly, and the forcefully contract the abdominal muscles and exhale the breath vigorously with the sound of “ha”, to cough effectively and expel sputum. It should be noted that the expectoration should be covered with a closed plastic bag, and the airway secretions should be placed in a special container to avoid infecting others.
• 3) Exercise therapy: The primary purpose is to improve muscle strength, relieve fatigue, improve daily activities, eliminate depression, reduce anxiety, and help sleep. In the choice of exercise therapy, strength training and endurance training of upper and lower limbs can be carried out. It is advisable to have no fatigue on the second day. Exercise should be for 15-45 minutes at a time and should occur two times a day. Specific forms can be cross-walking training, breathing rehabilitation exercises, and tai chi chuan, etc., to maintain motor function as much as possible to meet the needs of independent daily life activities. Exercise can be divided into small sections to facilitate self-observation and strictly avoid fatigue. If the patient cannot stand, they can choose a sitting/semirecumbent/recumbent position. Under the guidance of educational videos and brochures, perform light exercises on the limbs and torso.
• 4) Physiotherapy: At present, there is no precise evidence-based medicine to prove the therapeutic effect of physiotherapy on this disease; however it can be attempted.

a. Ultrashort wave therapy: Lung antithesis with no heat or micro heat for 10-15 minutes each time, once a day, and 10 times for a course of treatment. Patients whose body temperature exceeds 38 °C should not use this therapy.

b. Ultraviolet therapy: Irradiate chest or back skin by weak erythema, once a day, and four times as a course of treatment.

• 5) Occupational therapy: The purpose is to block the vicious circle of shortness of breath caused by mental and muscle tension, reduce the consumption of body energy, and improve the state of hypoxia as well as improve the patient’s anxiety, tension, fear, and other emotions. Self-relaxation activities should be the foremost choice, specifically, slow and deep breathing, natural swinging of the upper limbs while sitting or standing, music therapy, etc.
• 6) Patient education: Conduct publicity and education on the cause, clinical manifestations, prognosis, the importance of rehabilitation treatment, methods, purposes, precautions, etc., of COVID-19, in order to help patients, understand the knowledge of the disease, enhance their confidence in overcoming the disease, and maximize compliance. Help patients to work regularly, get enough sleep, have a balanced diet, and quit smoking.
• 7) Psychological intervention: Because patients do not understand the disease, they often experience fear, anxiety, anger, depression, and insomnia, or they do not cooperate, give up treatment, and other psychological problems. Intervene in these psychological problems by seeking a mental health professional or a psychological hotline.